With twin girls born at 35 weeks and five days who spent their first two weeks in the Newborn Intensive Care Unit (NICU), Sara Bozler worried about whether her babies were eating and getting the nutrition they needed.
Feeding problems are common with pre-term babies, and often these problems continue after the babies go home. Watching so many families struggle with feeding issues, the team at MoBap worked to establish an innovative Infant Feeding Clinic to help.
“Working in the NICU, I knew that our babies and moms were leaving with ongoing feeding questions and concerns,” said Elisa Doherty, occupational therapist and lactation counselor. “We needed an outpatient setting where we could work with these infants on developmental skills and feeding modifications to promote a healthy start.”
Because her daughters, Brooklyn and Charlee, were not latching consistently at first, Bozler continued to see Doherty through the Infant Feeding Clinic after leaving the NICU. The clinic is a program at the Center for Outpatient Therapy and Wellness at Missouri Baptist.
“I was so nervous and unsure of myself because I was not just a first-time mom, but I had twins,” Bozler recalled. “My goal was to tandem breastfeed, and I achieved that goal thanks to Elisa.”
“I still tell every new mom I meet that the only thing that could get me out of the house with newborn twins was going to see Elisa. She not only helped with feeding, but was also there as a supportive fellow mom who offered great advice,” Bozler said. “It was nice to have an experienced mom’s perspective along with her professional background as an OT and lactation counselor.”
Back in the NICU
A few years later, Bozler called on the expertise of Doherty and the Infant Feeding Clinic again. In November 2016, Bozler and her husband had another set of twins. A son, Beckett, and a daughter, Jocelyn, arrived at 35 weeks and four days. These twins weighed six-and-a-half pounds each; their stay in the NICU was only one week this time.
“Once again, I had babies who didn’t want to latch,” Bozler said.
“After being discharged, we visited the Infant Feeding Clinic for a few weeks. I felt more confident about what I was doing this time, and Elisa helped me reach my goal of having them latch and tandem breastfeed again.”
Bozler said she really appreciated the personalized care she received from everyone at MoBap, from labor and delivery to the NICU and the Infant Feeding Clinic. “My first time with twins, Elisa was there to help me with the new mom stuff, and the second time the focus was more on feeding. She sees a situation and provides the individualized care that it requires.”
“There are so many high expectations for new moms and breastfeeding, but the clinic and the therapists really focus on the babies,” she said. “As a patient and parent, I feel they always had the best interest of my babies at heart, and as a mom, it was so important to me to have someone who was supportive in a respectful way.”
Doherty says, “Every baby we treat has a unique story to tell. Every family structure and balance is different. The babies have varying levels of oral-motor development, physical and brain development, and endurance for feeding. We adapt individual feeding plans to fit the infants based upon their unique strengths and challenges. Being a part of their story and helping these infants achieve a great start to life, while also offering moms support, is the most rewarding part of my job.”
Infant Feeding Clinic at the Center for Outpatient Therapy and Wellness at Missouri Baptist
More than 400 babies have been helped by the clinic at Missouri Baptist, which enabled them to become better “feeders.” In the two short years since the Infant Feeding Clinic at MoBap’s Center for Outpatient Therapy and Wellness was launched, this clinic has become a haven for moms and babies who are experiencing early feeding issues.
Doherty elaborated, “It’s important to know that one in every 11 births is a late pre-term infant and that late pre-term infants account for nearly one-third of NICU admissions. One of the challenges in understanding the needs of a late pre-term infant is that they look healthy and strong just like a full-term infant, but behind that ‘healthy newborn appearance’ is a baby who struggles to thrive with its new environmental challenges. Factors like body temperature, breathing patterns, feeding coordination, jaundice and blood sugar levels may be unstable and contribute to an infant’s ability to remain alert, ready and able to feed.”
“We originally thought the majority of our babies would be NICU graduates and other pre-term babies born before 37 weeks. However, even a full-term baby can have difficulty gaining weight, achieving a good latch with adequate milk transfer, or transitioning to a bottle,” she said.
Most babies begin showing improvement within two visits to the clinic, and babies and moms typically reach their goals with a manageable feeding plan in only four visits. The clinic is readily accessible and often able to take infants with urgent needs for same-day evaluations Monday through Friday. With a physician’s referral, the cost of this therapy is usually covered by insurance with a minimal co-pay.
“We want moms, pediatricians and other physicians to know that we’re here to help,” Doherty said. “We have the experience to understand what the babies are telling us and know how to support their growth and development through oral-motor skill development, positioning and environmental modifications to help them achieve successful feedings.”
What can occupational therapists do to address early feeding issues?
- Assist infants in the coordination of feeding (suck-swallow-breathe pattern)
- Increase success with feeding (bottle or breast)
- Recommend bottles/nipples that are appropriate to the infant’s abilities
- Educate parents on feeding techniques and positioning options
- Provide environmental change recommendations and calming techniques for infants
Signs that an infant may benefit from occupational therapy:
- Infant takes longer than 30 minutes to feed
- Caregiver needs to offer chin or cheek support continuously during the feeding to achieve necessary volume (example: caregiver feels like she is working harder than the baby)
- Infant is a “sloppy” feeder
- Infant has difficulty with overall coordination of feeding — either bottle or breast
- Infant is experiencing weight loss or not adequately gaining weight despite other efforts